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Gonorrhea

Gonorrhea is a curable sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae. These bacteria can infect the genital tract, mouth, and rectum of both men and women.

In women, the opening to the uterus, the cervix, is the first place of infection. The disease can spread into the uterus and fallopian tubes, resulting in pelvic inflammatory disease (PID). PID affects more than 1 million women in this country every year and can cause tubal (ectopic) pregnancy and infertility in as many as 10 percent of infected women.

In 2002, 351,852 cases of gonorrhea were reported to the Centers for Disease Control and Prevention (CDC). In the United States, approximately 75 percent of all reported cases of gonorrhea are found in people aged 15 to 29 years. The highest rates of infection are usually found in 15- to 19-year old women and 20- to 24-year-old men.

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SYMPTOMS

The bacteria are carried in semen and vaginal fluids and cause a discharge. Symptoms usually appear within 2 to 10 days after sexual contact with an infected partner. For women, the early symptoms of gonorrhea often are mild. A small number of people may be infected for several months without showing symptoms.

When women have symptoms, the first ones may include

Bleeding associated with vaginal intercourse

Painful or burning sensations when urinating

Yellow or bloody vaginal discharge

More advanced symptoms, which may indicate development of PID, include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Men have symptoms more often than women, including

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Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood in the feces. Symptoms typically appear 2 to 5 days after infection but could appear as long as 30 days.

DIAGNOSIS

Health care providers usually use three laboratory techniques to diagnose gonorrhea.

Staining samples directly for the bacterium

Detecting bacterial genes or DNA in urine

Growing the bacteria in laboratory cultures

Many providers prefer to use more than one test to increase the chance of an accurate diagnosis.

The staining test involves placing a smear of the discharge from the penis or the cervix on a slide and staining the smear with a dye. Then the health care provider uses a microscope to look for bacteria on the slide. You usually can get the test results while in the office or clinic. This test is quite accurate for men but is not good in women. Only one in two women with gonorrhea has a positive stain.

More often, health care providers use urine or cervical swabs for a new test that detects the genes of the bacteria. These tests are more accurate than culturing the bacteria.

The laboratory culture test involves placing a sample of the discharge onto a culture plate and incubating it up to 2 days to allow the bacteria to grow. The sensitivity of this test depends on the site from which the sample is taken. Cultures of cervical samples detect infection approximately 90 percent of the time. The health care provider also can take a culture to detect gonorrhea in the throat. Culture also allows testing for drug-resistant bacteria.

TREATMENT

Health care providers usually prescribe a single dose of one of the following antibiotics to treat gonorrhea.

Cefixime

Ceftriaxone

Ciprofloxacin

Ofloxacin

Levofloxacin

If you are pregnant, or are younger than 18 years old, you should not take ciprofloxacin or ofloxacin. Your health care provider can prescribe the best and safest antibiotic for you.

Gonorrhea and chlamydia, another common STI, often infect people at the same time. Therefore, doctors usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases.

If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms.

PREVENTION

The surest way to avoid transmission of STIs is to abstain from sexual contact or be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

By using latex condoms correctly and consistently during vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and its complications.

COMPLICATIONS

In untreated gonorrhea infections, the bacteria can spread up into the reproductive tract, or more rarely, can spread into the blood stream and infect the joints, heart valves, or the brain.

The most common result of untreated gonorrhea is PID, a serious infection of the female reproductive tract. Gonococcal PID often appears immediately after the menstrual period. PID causes scar tissue to form in the fallopian tubes. If the tube is partially scarred, the fertilized egg may not be able to pass into the uterus. If this happens, the embryo may implant in the tube causing a tubal (ectopic) pregnancy. This serious complication may result in a miscarriage and can cause death of the mother.

In men, gonorrhea causes epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Also, gonorrhea affects the prostate gland and causes scarring in the urine canal.

Rarely, untreated gonorrhea can spread through the blood to the joints. This can cause an inflammation of the joints which is very serious.

If you are infected with gonorrhea, your risk of getting HIV infection increases (HIV, human immunodeficiency virus, causes AIDS). Therefore, it is extremely important for you to either prevent yourself from getting gonorrhea or get treated early if you already are infected with it.

TRANSMISSION TO NEWBORN BABIES OR CHILDREN

If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through the birth canal during delivery. A health care worker can prevent infection of your baby’s eyes by applying silver nitrate or other medicine to the eyes immediately after birth. Because of the risks from gonococcal infection to both you and your baby, health experts recommend that pregnant women have at least one test for gonorrhea during prenatal care.

When gonorrhea occurs in the genital tract, mouth, or rectum of a child, it is due most commonly to sexual abuse.

RESEARCH

The National Institute of Allergy and Infectious Diseases (NIAID) continues to support a comprehensive, multidisciplinary program of research on N. gonorrhoeae (gonoccoci). Researchers are trying to understand how gonococci infect cells while evading defenses of the human immune system. Studies are ongoing to determine

How this bacterium attaches to host cells

How it gets inside cells

Gonococcal surface structures and how they can change

Human response to infection by gonococci

Together, these efforts have led to, and will lead to, further improvements in diagnosis and treatment of gonorrhea. They also will lead to development o